Healthcare Provider Details

I. General information

NPI: 1376212308
Provider Name (Legal Business Name): JIANNA MARIE TABACHINO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8261 MARKET ST
BOARDMAN OH
44512-6254
US

IV. Provider business mailing address

8261 MARKET ST
BOARDMAN OH
44512-6254
US

V. Phone/Fax

Practice location:
  • Phone: 330-286-0050
  • Fax:
Mailing address:
  • Phone: 330-286-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.431448
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: